Case Report: Subfertility and Pregnancy Loss due to Genital Tuberculosis

Area of Science:

• Reproductive Medicine
• Infectious Diseases
• Pathology

Background:

• Genital tuberculosis (TB) is a significant cause of subfertility, particularly in women from high TB-burden regions.
• It often presents with non-specific symptoms, mimicking other gynecological conditions, leading to diagnostic challenges.
• Increasing migration necessitates greater awareness of TB in Western countries, especially among women with fertility issues.

Observation:

• A 34-year-old woman from Ivory Coast, with a history of pelvic inflammatory disease and fertility treatments, presented with premature delivery and retained placenta.
• Pathological examination revealed granulomatous inflammation consistent with intrauterine tuberculosis, not placental tissue.
• The patient was diagnosed with rifampicin-resistant TB.

Findings:

• Diagnosis of genital TB was confirmed post-delivery through hysteroscopy and pathology.
• The patient required a 15-month multi-drug-resistant TB treatment regimen.
• Rifampicin resistance complicated the treatment course.

Implications:

• This case highlights the diagnostic challenges of genital TB in subfertility and complicated pregnancies.
• It underscores the importance of considering TB in the differential diagnosis for unexplained infertility, especially in women from endemic areas.
• Suggests the need for targeted TB screening in specific populations during fertility investigations and early pregnancy screening.